The Effect of Estrogen on Water and Electrolyte Metabolism. I. The Normal

Abstract

The possibility that estrogens might under certain circumstances influence water and electrolyte metabolism is suggested by several observations. For instance, estrogens are related chemically to the strongly sodium-retaining steroid desoxycorticosterone (1); the recurrent ankle edema observed in some women before menstruation was considered by Fluhmann (2) to be associated with an increase in blood estrogen levels; and the edema frequently found in late pregnancy occurs at a time when estrogen production is at its height (3).These considerations led several workers to attempt to establish a direct relationship between water and salt retention on the one hand, and estrogenic activity on the other. Thorn and Engel (4) found sodium, chloride and water retention after a single injection of estrogen into male dogs. Later, the same group of workers (5), in a study of premenstrual fluid retention, found that decreased urinary excretion of salt and water was in two patients associated with an increased output of estrogenic material in the urine. Knowlton, Kenyon, Sandiford, Lotwin, and Fricker (6) found diminished urinary excretion of sodium following the daily administration of estradiol in one normal woman, but Sharpey-Schafer and Schrire (7), using twice the amount of estradiol in ten women, found no alteration in urinary volume. As part of an investigation into the possible role of estrogens in the fluid retention of liver disease it became necessary to establish the effect of continued estrogen administration on water and electrolyte metabolism in the normal. Water and electrolyte balance studies were therefore carried out in eleven normal subjects, and the effect of daily administration of estrogen observed. PROCEDUREEleven subjects without evidence of cardiac, hepatic, renal or other disease likely to affect water and electrolyte metabolism, were selected from the wards of The London Hospital. Five subjects were under treatment for peptic ulcer, during which time no medication other than magnesium trisilicate or aluminum hydroxide was given. Two subjects had sciatic nerve pain, one osteoarthritis of the hip, one torn medial meniscus of the knee, one hallux valgus, and in one a tuberculous pleural effusion had subsided three weeks previously.Each subject underwent a water and electrolyte balance study, lasting approximately two weeks and divided into two periods-the first a "control period," and the second an "estrogen period," during which daily injections of estrogen were given. The subjects were given a normal diet, gauged in amount and composition to individual appetite, and remaining constant throughout the study in respect of Cl, Na, K, PO, water and calorie content. Diet composition was calculated from appropriate tables (8). Sample dietary analyses were not carried out. The balance diet was commenced 2 to 3 days before any observations were made. Since this diet corresponded closely in composition to previous intake in each case, no longer period for metabolic adjustment was considered necessary. In ...

The Effect of Estrogen on Water and Electrolyte Metabolism. Ii. Hepatic Disease

“…The considerable and sustained retention of Cl, Na, and water observed in the group of cirrhosis with ascites following the administration of estrogen is in marked contrast with the effect of the same dosage in the normal (16). The changes in the cirrhotic group were apparent not only in the group as a whole (Table I, Figure 1 and 2) but also in each individual case, save one (No.…”

“…The prominent increases in weight in the absence of NaCl retention, observed in some cases of infective hepatitis and cirrhosis without ascites after estrogen, may be attributable to increased tissue formation, as in the normal group (16).…”

“…These observations suggest that decreased inactivation of endogenous estrogen may occur in human liver disease, which may lead in turn to sodium-retention. Under these circumstances the administration of exogenous estrogen to cases of liver disease would be expected to result in far greater retention of sodium than in normal subjects (16).…”

Effect of estrogen on calcium and sodium transport by the nephron luminal membranes

“…For many years now, clinical observations and clearance studies have clearly established an association between estrogen status and sodium (Na + ) retention in normal dogs (Johnson & Davis 1976), in women during the estrogenic cycle (Thorn et al 1938, Preedy & Aitken 1956) and in postmenopausal women injected with 17 -estradiol (Dignam et al 1956). This effect appears to be independent of mineralocorticoid secretion.…”

Identification and Partial Characterization of Specific Oestrogen-Binding Components in Human Kidney

“…However, there are some indications of oestradiol binding to cytosol macromolecules and the nuclear fraction of rat kidney (4,5). Moreover, oestrogens have been shown to decrease renal sodium excretion in adrenalectomized rats (4), dogs (6), and normal humans (7). These studies prompted an examination of normal human kidney for oestrogen-binding components.…”